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Bellini A, Scotto di Palumbo A, Nicolò A, Bazzucchi I, Sacchetti M. Exercise Prescription for Postprandial Glycemic Management. Nutrients 2024; 16:1170. [PMID: 38674861 PMCID: PMC11053955 DOI: 10.3390/nu16081170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
The detrimental impacts of postprandial hyperglycemia on health are a critical concern, and exercise is recognized a pivotal tool in enhancing glycemic control after a meal. However, current exercise recommendations for managing postprandial glucose levels remain fairly broad and require deeper clarification. This review examines the existing literature aiming to offer a comprehensive guide for exercise prescription to optimize postprandial glycemic management. Specifically, it considers various exercise parameters (i.e., exercise timing, type, intensity, volume, pattern) for crafting exercise prescriptions. Findings predominantly indicate that moderate-intensity exercise initiated shortly after meals may substantially improve glucose response to a meal in healthy individuals and those with type 2 diabetes. Moreover, incorporating short activity breaks throughout the exercise session may provide additional benefits for reducing glucose response.
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Affiliation(s)
| | | | | | - Ilenia Bazzucchi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro De Bosis 6, 00135 Rome, Italy; (A.B.); (A.S.d.P.); (A.N.); (M.S.)
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2
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Perks J, Mcbride P, Rayt H, Payne T, Edwardson C, Rowlands AV, Messeder SJ, Yates T, Sayers R. Efficacy of a personalised activity plan for BREAKing UP sitting time in patients with intermittent claudication (the BREAK UP study). Diabetes Res Clin Pract 2023; 204:110925. [PMID: 37774979 DOI: 10.1016/j.diabres.2023.110925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the concept of an 8-week personalised activity plan, using short periods of physical activity to break up sitting time in people with Intermittent Claudication (IC), to improve walking ability, and reduce time spent sitting. METHODS The study was designed as a single centre, single arm, before and after study and is registered with clinicaltrials.gov (NCT04572737). The co-primary outcomes are time spent sitting and walking ability measured via the walking impairment questionnaire. Normally distributed data was analysed using paired samples T-tests; non-normally distributed data was analysed using related-samples Wilcoxon signed rank tests. RESULTS There was a significant improvement in both co-primary outcomes: walking ability and time spent sitting, as well as the following secondary outcomes: total bouts and time spent in prolonged sitting, time spent standing and stepping, anxiety, depression, and activity levels reported on the vascular quality of life questionnaire. CONCLUSION An 8-week personalised activity plan to break up sitting time shows promise as a treatment for people with IC, improving walking ability and reducing time spent sitting. This study supports the use of large randomised controlled trials to further develop this treatment in people with IC.
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Affiliation(s)
- Jemma Perks
- Department of Cardiovascular Sciences, University of Leicester, On-Call Suite OC9, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK.
| | - Philip Mcbride
- Leicester Diabetes Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Harjeet Rayt
- Department of Cardiovascular Sciences, University of Leicester, On-Call Suite OC9, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Tanya Payne
- Department of Cardiovascular Sciences, University of Leicester, On-Call Suite OC9, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK
| | | | - Alex V Rowlands
- Leicester Diabetes Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Sarah Jane Messeder
- Department of Cardiovascular Sciences, University of Leicester, On-Call Suite OC9, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Thomas Yates
- Leicester Diabetes Centre, University of Leicester, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, UK
| | - Robert Sayers
- Department of Cardiovascular Sciences, University of Leicester, On-Call Suite OC9, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK
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Edwardson CL, Maylor BD, Biddle SJ, Clemes SA, Cox E, Davies MJ, Dunstan DW, Eborall H, Granat MH, Gray LJ, Hadjiconstantinou M, Healy GN, Jaicim NB, Lawton S, Mandalia P, Munir F, Richardson G, Walker S, Yates T, Clarke-Cornwell AM. A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT. PUBLIC HEALTH RESEARCH 2023; 11:1-229. [PMID: 37786938 DOI: 10.3310/dnyc2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background Office workers spend 70-85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time. Objective Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up. Design A three-arm cluster randomised controlled trial. Setting Councils in England. Participants Office workers. Intervention SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months. Main outcome measures The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected. Results A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval -38.8 to -5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval -80.0 to -47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval -56.3 to -27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively. Limitations The study was carried out in one sector, limiting generalisability. Conclusions The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time. Future work There is a need for longer-term follow-up, as well as follow-up within different organisations. Trial registration Current Controlled Trials ISRCTN11618007.
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Affiliation(s)
| | | | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Stacy A Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Sarah Lawton
- School of Health & Society, University of Salford, Salford, UK
| | - Panna Mandalia
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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5
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Duran AT, Friel CP, Serafini MA, Ensari I, Cheung YK, Diaz KM. Breaking Up Prolonged Sitting to Improve Cardiometabolic Risk: Dose-Response Analysis of a Randomized Crossover Trial. Med Sci Sports Exerc 2023; 55:847-855. [PMID: 36728338 DOI: 10.1249/mss.0000000000003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Sedentary time is ubiquitous in developed nations and is associated with deleterious health outcomes. Physical activity guidelines recommend reductions in sedentary time; however, quantitative guidelines that inform how often and how long sedentary time should be interrupted have not been provided. The purpose of this study was to examine the acute effects of multiple doses of a sedentary break intervention on cardiometabolic risk factors, concurrently evaluating efficacy of varying frequencies and durations of sedentary breaks. METHODS In a randomized crossover study, middle- and older-age adults ( n = 11) completed the following 8-h conditions on five separate days: 1 uninterrupted sedentary (control) condition and four acute (experimental) trials that entailed different sedentary break frequency/duration combinations: every 30 min for 1 min, every 30 min for 5 min, every 60 min for 1 min, and every 60 min for 5 min. Sedentary breaks entailed light-intensity walking. Glucose and blood pressure (BP) were measured every 15 and 60 min, respectively. RESULTS Compared with control, glucose incremental area under the curve was significantly attenuated only for the every 30 min for 5-min dose (-11.8[4.7]; P = 0.017). All sedentary break doses yielded significant net decreases in systolic BP from baseline compared with control ( P < 0.05). The largest reductions in systolic BP were observed for the every 60 min for 1 min (-5.2 [1.4] mm Hg) and every 30 min for 5 min (-4.3[1.4] mm Hg) doses. CONCLUSIONS The present study provides important information concerning efficacious sedentary break doses. Higher-frequency and longer-duration breaks (every 30 min for 5 min) should be considered when targeting glycemic responses, whereas lower doses may be sufficient for BP lowering.
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Affiliation(s)
- Andrea T Duran
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Ciaran P Friel
- Institute of Health System Science, Feinstein Institutes of Medical Research, Northwell Health, Manhasset, NY
| | - Maria A Serafini
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Ipek Ensari
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY
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Tyldesley-Marshall N, Greenfield SM, Parretti HM, Gokal K, Greaves C, Jolly K, Maddison R, Daley AJ. Snacktivity™ to Promote Physical Activity: a Qualitative Study. Int J Behav Med 2021; 29:553-564. [PMID: 34782996 PMCID: PMC8592280 DOI: 10.1007/s12529-021-10040-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/24/2022]
Abstract
Background Adults should achieve a minimum of 150 min of moderate-to-vigorous intensity physical activity per week, but many people do not achieve this. Changes to international guidance have removed the requirement to complete physical activity in bouts of at least 10 min. Snacktivity is a novel and complementary approach that could motivate people to be physically active. It focuses on promoting shorter (2–5 min) and more frequent bouts, or ‘snacks’ of physical activity throughout the day. It is not known whether promoting physical activity in shorter bouts is acceptable to the public, or whether it likely to translate into health behaviour change. Methods As part of a larger research programme, this study explored the merits of using small bouts of physical activity to help the public become physically active (the Snacktivity™ programme). Thirty-one inactive adults used the approach for five days then participated in semi- structured interviews about their experiences. The data were analysed using the Framework approach. Results Whilst participants highlighted some potential barriers to implementation, they expressed the ease with which Snacktivity could be achieved, which gave them a new awareness of opportunities to do more physical activity throughout the day. Participants raised the importance of habit formation to achieve regular small bouts of physical activity. Conclusions Findings demonstrated that participants liked the Snacktivity concept and viewed it as a motivating approach. Guidance about physical activity must lead to advice that has the best chance of preserving and promoting health and Snacktivity has potential to meet this ambition. Supplementary Information The online version contains supplementary material available at 10.1007/s12529-021-10040-y.
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Affiliation(s)
- Natalie Tyldesley-Marshall
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, Leicestershire, UK
| | - Sheila M Greenfield
- Institute for Applied Health Research, School of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Helen M Parretti
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - Kajal Gokal
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, Leicestershire, UK
| | - Colin Greaves
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Kate Jolly
- Institute for Applied Health Research, School of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour (CLiMB), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, Leicestershire, UK.
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Nagayama C, Burns SF, Thackray AE, Stensel DJ, Miyashita M. Postprandial Metabolism and Physical Activity in Asians: A Narrative Review. Int J Sports Med 2021; 42:953-966. [PMID: 34374040 PMCID: PMC8486483 DOI: 10.1055/a-1493-2948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/15/2021] [Indexed: 10/27/2022]
Abstract
The widespread benefits of physical activity in enhancing health and lowering the risk of non-communicable chronic diseases are well established across populations globally. Nevertheless, the prevalence of several lifestyle-related chronic diseases, including cardiovascular disease, varies markedly across countries and ethnicities. Direct ethnic comparative studies on the health benefits of physical activity are sparse and evidence-based physical activity guidelines are not ethnicity-specific. Indeed, physical activity guidelines in some Asian countries were developed primarily based on data from Western populations even though the magnitude of potential benefit may not be the same among different ethnic groups. Unfavorable diurnal perturbations in postprandial triglycerides and glucose are risk factors for cardiovascular disease. This narrative review summarizes differences in these risk factors primarily between individuals of Asian and white European descent but also within different Asian groups. Moreover, the variable effects of physical activity on mitigating risk factors among these ethnic groups are highlighted along with the underlying metabolic and hormonal factors that potentially account for these differences. Future ethnic comparative studies should include investigations in understudied ethnic groups, such as those of East Asian origin, given that the effectiveness of physical activity for ameliorating cardiovascular disease varies even among Asian groups.
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Affiliation(s)
- Chihiro Nagayama
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Stephen F. Burns
- Department of Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore
| | - Alice E. Thackray
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom of Great Britain and Northern Ireland
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
| | - David J. Stensel
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom of Great Britain and Northern Ireland
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, United Kingdom of Great Britain and Northern Ireland
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Schwartz J, Oh P, Perotto MB, Rhodes RE, Firth W, Bredin SSD, Gaytán-González A, Warburton DER. A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security. Front Cardiovasc Med 2021; 8:730373. [PMID: 34527714 PMCID: PMC8435680 DOI: 10.3389/fcvm.2021.730373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/10/2021] [Indexed: 01/12/2023] Open
Abstract
In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.
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Affiliation(s)
- Juliano Schwartz
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Maira B. Perotto
- West Toronto Diabetes Education Program, LAMP Community Health Centre, Toronto, ON, Canada
| | - Ryan E. Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Wanda Firth
- Hearts & Health in Motion Program, Nova Scotia Health, QEII Health Sciences Centre, Halifax, NS, Canada
| | - Shannon S. D. Bredin
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
| | - Alejandro Gaytán-González
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
- Institute of Applied Sciences for Physical Activity and Sport, University of Guadalajara, Guadalajara, Mexico
| | - Darren E. R. Warburton
- Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
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10
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Quan M, Xun P, Wu H, Wang J, Cheng W, Cao M, Zhou T, Huang T, Gao Z, Chen P. Effects of interrupting prolonged sitting on postprandial glycemia and insulin responses: A network meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:419-429. [PMID: 33359636 PMCID: PMC8343076 DOI: 10.1016/j.jshs.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/11/2020] [Accepted: 10/30/2020] [Indexed: 06/07/2023]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of physical activity (PA) interrupting prolonged sitting (PS) on postprandial glycemia and insulin responses among adults. METHODS PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, PsycINFO, and the China National Knowledge Infrastructure databases were searched through September 30, 2020. Randomized controlled trials (RCTs) that examined the effect of all forms of PA interrupting PS on postprandial glycemia and/or insulin responses among adults without chronic diseases were included in this study. The risk of bias of included studies was evaluated based on the Cochrane tool. A network meta-analysis was performed to estimate the summary standardized mean differences (SMDs) with 95% confidence intervals (95%CIs) with random effects. RESULTS Thirty crossover RCTs were included in our review. These RCTs included 9 types of interventions that interrupted PS. When compared to PS by itself, light-intensity PA intermittent interrupting (LPA-INT) PS and moderate-intensity PA intermittent interrupting (MPA-INT) PS significantly lowered postprandial glycemia (SMD = -0.46, 95%CI: -0.70 to -0.21; SMD = -0.69, 95%CI: -1.00 to -0.37, respectively) and significantly reduced postprandial insulin response (SMD = -0.46, 95%CI: -0.66 to -0.26; SMD = -0.47, 95%CI: -0.77 to -0.17, respectively). Results of the clustered ranking plot indicated that MPA-INT was the most effective intervention in lowering postprandial glycemia and insulin responses. CONCLUSION Replacing PS with MPA-INT or LPA-INT has a positive effect in reducing postprandial glycemia and insulin responses, with MPA-INT being the optimal intervention strategy.
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Affiliation(s)
- Minghui Quan
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China.
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN 47405, USA
| | - Hua Wu
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | - Jing Wang
- School of Sports Science and Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Wei Cheng
- Department of Endocrinology, Yangpu Hospital Affiliated to Tongji University, Shanghai 200090, China
| | - Meng Cao
- Institute of Physical Education, Normal College, Shenzhen University, Shenzhen 518061, China
| | - Tang Zhou
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Tao Huang
- Department of Physical Education, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zan Gao
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Peijie Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China.
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11
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Pettit-Mee RJ, Ready ST, Padilla J, Kanaley JA. Leg Fidgeting During Prolonged Sitting Improves Postprandial Glycemic Control in People with Obesity. Obesity (Silver Spring) 2021; 29:1146-1154. [PMID: 34159757 PMCID: PMC8231734 DOI: 10.1002/oby.23173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Studies have shown that fidgeting augments metabolic demand and increases blood flow to the moving limbs, whereas prolonged sitting suppresses these factors and exacerbates postprandial glucose excursions. Therefore, the hypothesis of this study was that leg fidgeting during prolonged sitting would improve postprandial glycemic control. METHODS Adults with obesity (n = 20) participated in a randomized crossover trial in which blood glucose and insulin concentrations were measured during a 3-hour sitting period following the ingestion of a glucose load (75 g). During sitting, participants either remained stationary or intermittently fidgeted both legs (2.5 minutes off and 2.5 minutes on). Accelerometer counts, oxygen consumption, and popliteal-artery blood flow were also measured during the sitting period. RESULTS As expected, fidgeting increased accelerometer counts (P < 0.01), oxygen consumption (P < 0.01), and blood flow through the popliteal artery (P < 0.05). Notably, fidgeting lowered both glucose (P < 0.01) and insulin (P < 0.05) total area under the curve (AUC) and glucose incremental AUC (P < 0.05). Additionally, there was a strong negative correlation between fidgeting-induced increases in blood flow and reduced postprandial glucose AUC within the first hour (r = -0.569, P < 0.01). CONCLUSIONS Leg fidgeting is a simple, light-intensity physical activity that enhances limb blood flow and can be incorporated during prolonged sitting to improve postprandial glycemic control in people with obesity.
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Affiliation(s)
- Ryan J. Pettit-Mee
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO
| | - Sean T. Ready
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO
| | - Jill A. Kanaley
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO
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12
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Does Interrupting Prolonged Sitting With 10- or 20-Min Standing Attenuate Postprandial Glycemia and Blood Pressure in Middle-Aged and Older Adults With Type 2 Diabetes? J Aging Phys Act 2021; 29:968-975. [PMID: 34157676 DOI: 10.1123/japa.2020-0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/26/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
We carried out three types of 2-hr experimental sessions with middle-aged and older adults with Type 2 diabetes in order to examine the acute effect of interrupting prolonged sitting with varying periods of standing on postprandial glycemia and blood pressure (BP): (a) prolonged sitting after breakfast; (b) standing for 10 min, 30 min after breakfast; and (c) standing for 20 min, 30 min after breakfast. Glucose and BP were assessed before and after breakfast. A generalized linear model revealed no significant differences for the incremental area under the curve of glucose between standing for 10 min, 30 min after breakfast, versus prolonged sitting after breakfast (β = -4.5 mg/dl/2 hr, 95% CI [-17.3, 8.4]) and standing for 20 min, 30 min after breakfast, versus prolonged sitting after breakfast (β = 0.9 mg/dl/2 hr, 95% CI [-11.9, 13.7]). There was no difference in area under the curve of systolic and diastolic BP among the sessions. Interrupting prolonged sitting time with 10 or 20 min of standing 30 min after breakfast does not attenuate postprandial glycemia or BP in middle-aged and older adults with Type 2 diabetes.
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13
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English C, Weerasekara I, Carlos A, Chastin S, Crowfoot G, Fitzsimons C, Forster A, Holliday E, Janssen H, Mackie P, Mead G, Dunstan D. Investigating the rigour of research findings in experimental studies assessing the effects of breaking up prolonged sitting - extended scoping review. Braz J Phys Ther 2021; 25:4-16. [PMID: 32439303 PMCID: PMC7817869 DOI: 10.1016/j.bjpt.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Sedentary behaviour research is a relatively new field, much of which has emerged since the widespread acceptance of clinical trial registration. The aim of this study was to investigate the trial registration and related issues in studies investigating the effect of frequent activity interruptions to prolonged sitting-time. METHODS Secondary analysis of a scoping review including systematic searches of databases and trial registries. We included experimental studies investigating the effects of frequent activity interruptions to prolonged sitting-time. RESULTS We identified 32 trials published in 45 papers. Only 16 (50%) trials were registered, with all 16 trials being completed and published. Of the unregistered trials, we identified three (19%) for which similarities in the sample size and participant demographics across papers was suggestive of duplicate publication. Identification of potential duplicate publications was difficult for the remaining 13 (81%). Results from 53 (76%) of the 70 registered outcomes were published, but 11 (69%) registered trials reported results from additional outcomes not prospectively registered. A total of 46 different outcomes (out of 53 reported outcome measures, similar measures were collated) were reported across all trials, 31 (67%) of which were collected in ≤2 trials. CONCLUSIONS We found direct evidence of trial registration issues in experimental trials of breaking up sitting-time. The lack of prospective registration of all trials, and the large number of outcomes measured per trial are key considerations for future research in this field. These issues are unlikely to be confined to the field of sedentary behaviour research.
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Affiliation(s)
- Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, Newcastle, Australia.
| | - Ishanka Weerasekara
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Anjelica Carlos
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
| | - Sebastien Chastin
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; School of Health and Life Science, Institute of Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Gary Crowfoot
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre, Institute of Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford, UK
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Heidi Janssen
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Paul Mackie
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Newcastle, Australia; Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Gillian Mead
- Geriatric Medicine, Division of Health Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - David Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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14
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Ma SX, Zhu Z, Zhang L, Liu XM, Lin YY, Cao ZB. Metabolic Effects of Three Different Activity Bouts during Sitting in Inactive Adults. Med Sci Sports Exerc 2020; 52:851-858. [PMID: 31764465 DOI: 10.1249/mss.0000000000002212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to determine whether interrupting prolonged sitting with three different walking-bout schedules improves glycemic metabolism relative to continuous prolonged sitting in sedentary adults. METHODS In a randomized, crossover trial, 16 inactive healthy adults (7 men, 24 ± 3 yr old) completed four 26-h laboratory sessions, including 22.5 h in an energy expenditure (EE)-testing calorimeter chamber. The four 9-h intervention periods were as follows: 9-h uninterrupted sitting (SIT), 30-min sitting/3-min brisk (60% V˙O2max) treadmill walk (WALK3), 45-min sitting/5-min (WALK5), or 60-min sitting/8-min (WALK8). Coprimary outcomes included the difference in the mean interstitial glucose concentration, total area under the curve (tAUC), and incremental area under the curve (iAUC) for the entire 26 and 9 h (intervention period) during three activity-bout conditions compared with SIT. RESULTS Compared with SIT, the 26-h mean glucose concentration was attenuated in WALK8 (Δmean -0.22 mmol·L [95% confidence interval = -0.43 to -0.001], P = 0.048) without adjustment for EE and attenuated in WALK3 (Δ-0.47 mmol·L [-0.75 to -0.10]), WALK5 (Δ-0.47 mmol·L [-0.83 to -0.10]), and WALK8 (Δ-0.53 mmol·L [-0.92 to -0.13]) after adjustment for EE (all P < 0.01). The 26-h tAUC was reduced in WALK3 (Δ-11.18 mmol·L per 26 h [-20.07 to -2.29]), WALK5 (2.12.67 mmol·L per 26 h [-22.54 to -2.79]), and WALK8 (Δ-13.85 mmol·L per 26 h [-24.60 to -3.10]) (all P < 0.01), as well as the iAUC (all P < 0.05), only after adjustment for EE. The 9-h mean glucose concentration, tAUC, and iAUC decreased in the three activity-break conditions regardless of EE adjustment (all P < 0.05). CONCLUSIONS All three walking-bout conditions improved glycemic metabolism compared with SIT, independent of EE, in inactive, healthy adults.
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Affiliation(s)
- Sheng-Xia Ma
- School of Kinesiology, Shanghai University of Sport, Shanghai, CHINA
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15
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Henson J, Edwardson CL, Celis-Morales CA, Davies MJ, Dunstan DW, Esliger DW, Gill JMR, Kazi A, Khunti K, King J, McCarthy M, Sattar N, Stensel DJ, Velayudhan L, Zaccardi F, Yates T. Predictors of the Acute Postprandial Response to Breaking Up Prolonged Sitting. Med Sci Sports Exerc 2020; 52:1385-1393. [PMID: 31895295 DOI: 10.1249/mss.0000000000002249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To identify predictors of favorable changes to postprandial insulin and glucose levels in response to interrupting prolonged sitting time with standing or light-intensity physical activity. METHODS Data were combined from four similarly designed randomized acute cross-over trials (n = 129; body mass index [BMI] range, 19.6-44.6 kg·m; South Asian = 31.0%; dysglycemia = 27.1%). Treatments included: prolonged sitting (6.5 h) or prolonged sitting broken-up with either standing or light-intensity physical activity (5 min every 30 min). Time-averaged postprandial responses for insulin and glucose were calculated for each treatment (mean ± 95% confidence interval). Mutually adjusted interaction terms were used to examine whether anthropometric (BMI), demographic (age, sex, ethnicity [white European vs South Asian]) and a cardiometabolic variable (Homeostatic Model Assessment of Insulin Resistance)-modified responses. RESULTS Postprandial insulin and glucose were reduced when individuals interrupted prolonged sitting with bouts of light physical activity, but not with standing. Reductions in time-averaged postprandial insulin were more pronounced if individuals were South Asian compared with white European (-18.9 mU·L [-23.5%] vs -8.2 mU·L [-9.3%]), female compared with male (-15.0 mU·L [-21.2%] vs -12.1 mU·L [-17.6%]) or had a BMI ≥27.2 kg·m (-20.9 mU·L [-22.9%] vs -8.7 mU·L [-18.2%]). Similarly, being female (-0.4 mmol·L [-0.6 mmol·L, -0.2 mmol·L], -6.8% vs -0.1 mmol·L [-0.3 mmol·L, 1 mmol·L], -1.7%) or having a BMI ≥27.2 kg·m (-0.4 mmol·L [-0.6 mmol·L, -0.2 mmol·L], -6.7% vs -0.2 mmol·L [-0.4 mmol·L, 0.0 mmol·L], -3.4%) modified the postprandial glucose response. No significant interactions were found for Homeostatic Model Assessment of Insulin Resistance or age. CONCLUSIONS Being female, South Asian, or having a higher BMI, all predicted greater reductions in postprandial insulin, whereas being female and having a higher BMI predicted greater reductions in postprandial glucose when sitting was interrupted with light physical activity. These results could help to guide personalized interventions in high-risk participants for whom breaking prolonged sitting time with light activity may yield the greatest therapeutic potential.
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Affiliation(s)
| | | | | | | | | | | | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UNITED KINGDOM
| | - Aadil Kazi
- NIHR Imperial Biomedical Research Centre, UNITED KINGDOM
| | | | | | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UNITED KINGDOM
| | | | - Latha Velayudhan
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, UNITED KINGDOM
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16
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Loh R, Stamatakis E, Folkerts D, Allgrove JE, Moir HJ. Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin and Triacylglycerol Measures: A Systematic Review and Meta-analysis. Sports Med 2020; 50:295-330. [PMID: 31552570 PMCID: PMC6985064 DOI: 10.1007/s40279-019-01183-w] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physical activity (PA) breaks in sitting time might attenuate metabolic markers relevant to the prevention of type 2 diabetes. OBJECTIVES The primary aim of this paper was to systematically review and meta-analyse trials that compared the effects of breaking up prolonged sitting with bouts of PA throughout the day (INT) versus continuous sitting (SIT) on glucose, insulin and triacylglycerol (TAG) measures. A second aim was to compare the effects of INT versus continuous exercise (EX) on glucose, insulin and TAG measures. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Eligibility criteria consisted of trials comparing INT vs. SIT or INT vs. one bout of EX before or after sitting, in participants aged 18 or above, who were classified as either metabolically healthy or impaired, but not with other major health conditions such as chronic obstructive pulmonary disease or peripheral arterial disease. RESULTS A total of 42 studies were included in the overall review, whereas a total of 37 studies were included in the meta-analysis. There was a standardised mean difference (SMD) of - 0.54 (95% CI - 0.70, - 0.37, p = 0.00001) in favour of INT compared to SIT for glucose. With respect to insulin, there was an SMD of - 0.56 (95% CI - 0.74, - 0.38, p = 0.00001) in favour of INT. For TAG, there was an SMD of - 0.26 (95% CI - 0.44, - 0.09, p = 0.002) in favour of INT. Body mass index (BMI) was associated with glucose responses (β = - 0.05, 95% CI - 0.09, - 0.01, p = 0.01), and insulin (β = - 0.05, 95% CI - 0.10, - 0.006, p = 0.03), but not TAG (β = 0.02, 95% CI - 0.02, 0.06, p = 0.37). When energy expenditure was matched, there was an SMD of - 0.26 (95% CI - 0.50, - 0.02, p = 0.03) in favour of INT for glucose, but no statistically significant SMDs for insulin, i.e. 0.35 (95% CI - 0.37, 1.07, p = 0.35), or TAG i.e. 0.08 (95% CI - 0.22, 0.37, p = 0.62). It is worth noting that there was possible publication bias for TAG outcomes when PA breaks were compared with sitting. CONCLUSION The use of PA breaks during sitting moderately attenuated post-prandial glucose, insulin, and TAG, with greater glycaemic attenuation in people with higher BMI. There was a statistically significant small advantage for PA breaks over continuous exercise for attenuating glucose measures when exercise protocols were energy matched, but no statistically significant differences for insulin and TAG. PROSPERO Registration: CRD42017080982. PROSPERO REGISTRATION CRD42017080982.
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Affiliation(s)
- Roland Loh
- School of Life Sciences, Pharmacy and Chemistry, Faculty of Science, Engineering and Computing, Kingston University, Penrhyn Road, Kingston upon Thames, Surrey, London, KT1 2EE, UK.
| | - Emmanuel Stamatakis
- Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Dirk Folkerts
- School of Life Sciences, Pharmacy and Chemistry, Faculty of Science, Engineering and Computing, Kingston University, Penrhyn Road, Kingston upon Thames, Surrey, London, KT1 2EE, UK.,Faculty of Sport and Exercise Sciences, University of Muenster, Münster, Germany
| | - Judith E Allgrove
- School of Life Sciences, Pharmacy and Chemistry, Faculty of Science, Engineering and Computing, Kingston University, Penrhyn Road, Kingston upon Thames, Surrey, London, KT1 2EE, UK
| | - Hannah J Moir
- School of Life Sciences, Pharmacy and Chemistry, Faculty of Science, Engineering and Computing, Kingston University, Penrhyn Road, Kingston upon Thames, Surrey, London, KT1 2EE, UK.
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17
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McCarthy M, Yates T, Webb D, Game F, Gray L, Davies MJ. Health impacts of seated arm ergometry training in patients with a diabetic foot ulcer: protocol for a randomised controlled trial. BMJ Open 2020; 10:e039062. [PMID: 32565482 PMCID: PMC7311002 DOI: 10.1136/bmjopen-2020-039062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Once diagnosed with a diabetic foot ulcer (DFU), patients are advised to offload, keeping pressure off the foot in order to facilitate ulcer healing. An increase in offloading is often accompanied by reductions in physical activity which can worsen the overall health of patients.While unable to perform traditional forms of upright activity, one mode of exercise that would allow patients to be physically active while adhering to offloading instruction is seated arm ergometry. The merits of tailored aerobic exercise in DFU remain unexplored. METHODS AND ANALYSIS This is a prospective open-label randomised controlled trial. Participants will be randomised to one of two groups, an exercise intervention group or control. The intervention group are required to undertake arm ergometry training at a moderate intensity (65%-75% HRpeak), three times per week for 12 weeks as individually prescribed by an exercise physiologist, while the control group will continue to receive standard care alone. Assessment of outcome measures will occur at baseline and after the intervention period, these will include: a seated VO2 peak test, a blood sample, a short physical performance battery, a dual-energy X-ray absorptiometry scan and completing a range of health-based questionnaires. The above will be used to determine: cardiorespiratory fitness, metabolic health, physical function, body composition and quality of life, respectively. Ulcer area will also be measured as an approximate marker of ulcer healing. ETHICS AND DISSEMINATION This trial has been approved by 'Yorkshire & The Humber-Leeds West Research Ethics Committee' (19/YH/0269). Trial results will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN16000053. Registered in accordance with WHO Trial Registration Data Set (version 1.3.1).
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Affiliation(s)
- Matthew McCarthy
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - David Webb
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Frances Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Laura Gray
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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18
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Mackie P, Weerasekara I, Crowfoot G, Janssen H, Holliday E, Dunstan D, English C. What is the effect of interrupting prolonged sitting with frequent bouts of physical activity or standing on first or recurrent stroke risk factors? A scoping review. PLoS One 2019; 14:e0217981. [PMID: 31194799 PMCID: PMC6563984 DOI: 10.1371/journal.pone.0217981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/22/2019] [Indexed: 11/18/2022] Open
Abstract
The objective of this review was to ascertain the scope of the available literature on the effects of interrupting prolonged sitting time with frequent bouts of physical activity or standing on stroke and recurrent stroke risk factors. Databases Medline, Embase, AMED, CINAHL and Cochrane library were comprehensively searched from inception until 21st February 2018. Experimental trials which interrupted sitting time with frequent bouts of physical activity or standing in adults (≥ 18 years) were included. Comparison to a bout of prolonged sitting and a measure of at least one first or recurrent stroke risk factor was required to be included. Overall, 30 trials (35 articles) were identified to meet the inclusion criteria. Fifteen trials were completed in participants at an increased risk of having a first stroke and one trial in participants at risk of a recurrent stroke. Outcomes of hypertension and dysglycemia were found to be more favourable following predominately light- to moderate-intensity bouts of physical activity or standing compared to sitting in the majority of trials in participants at risk of having a first stroke. In the one trial of stroke survivors, only outcomes of hypertension were significantly improved. These findings are of significant importance taking into consideration hypertension is the leading risk factor for first and recurrent stroke. However, trials primarily focused on measuring outcomes of dysglycemia and without assessing a dose-response effect. Additional research is required on the dose-response effect of interrupting sitting with frequent bouts of physical activity or standing on first and recurrent stroke risk factors, in those high risk population groups.
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Affiliation(s)
- Paul Mackie
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
- * E-mail:
| | - Ishanka Weerasekara
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Gary Crowfoot
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Heidi Janssen
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health University of Newcastle, Newcastle, Australia
| | - David Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
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19
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Efficacy of a Multicomponent Intervention to Reduce Workplace Sitting Time in Office Workers. J Occup Environ Med 2018; 60:787-795. [DOI: 10.1097/jom.0000000000001366] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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The Acute Metabolic and Vascular Impact of Interrupting Prolonged Sitting: A Systematic Review and Meta-Analysis. Sports Med 2018; 48:2347-2366. [DOI: 10.1007/s40279-018-0963-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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21
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Sargeant JA, Yates T, McCann GP, Lawson CA, Davies MJ, Gulsin GS, Henson J. Physical activity and structured exercise in patients with type 2 diabetes mellitus and heart failure. PRACTICAL DIABETES 2018. [DOI: 10.1002/pdi.2180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Jack A Sargeant
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Thomas Yates
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences; University of Leicester and the NIHR Leicester Biomedical Research Centre; Glenfield Hospital, Leicester UK
| | - Claire A Lawson
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Melanie J Davies
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences; University of Leicester and the NIHR Leicester Biomedical Research Centre; Glenfield Hospital, Leicester UK
| | - Joseph Henson
- Diabetes Research Centre; University of Leicester and the NIHR Leicester Biomedical Research Centre; Leicester General Hospital, Leicester UK
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